Health Expectations

IntroductionBreast cancer remains a prevalent disease in women worldwide. Though significant advancements in the standard of care for breast cancer have contributed to improved patient survival and quality of life, a breast cancer diagnosis and subsequent treatment interventions have a long-lasting impact on patients lived experiences. A high-quality healthcare system uses a patient-centred approach to healthcare, with patient engagement being a central pillar in the delivery of patient-centred care. However, the disconnect between patients and researchers can translate into research lacking real-world relevance to patient health needs. Here, we report a patient and stakeholder engagement workshop series that was conceptualized with the goal of promoting dialogue between patients with breast cancer, breast cancer researchers and the clinician involved in their care. We present the collaborative learning process and emerging opportunities from this patient engagement workshop series as a community-academic partnership. MethodWe report on a three-part storytelling workshop, with the scope of the workshops including topics related to raising awareness of the patient lived experience following a breast cancer diagnosis, breast cancer research activities undertaken by researchers, and the approach used by multidisciplinary healthcare teams in the management of breast cancer using storytelling as a tool. We used an iterative approach to cohort trust and relationship building, narrative development, and the use of multiple media formats to capture patient stories. This included the use of object memories, storytelling prompt cards and open-mic audio format to capture patient stories from diagnosis to treatment, and remission. Results20 patients shared their stories with key themes emerging from the qualitative analysis of audio recordings. For many, this was the first time they had spoken about their breast cancer experience beyond family and friends. Emerging themes included common public misconceptions about a breast cancer diagnosis, the importance of self-advocacy in patient decision making about treatment, and the complex emotional journey experienced by patients diagnosed with breast cancer. The group-based storytelling approach provided collective empowerment to share personal experiences and connect meaningfully across the peer community. ConclusionWhile a breast cancer diagnosis can be overwhelming from a physical, social, emotional and cognitive perspective, storytelling as a patient engagement approach can build patient trust in researchers, ensuring that as key stakeholders they are involved in the process of research. Understanding the patient perspective of a breast cancer diagnosis and subsequent experiences can support healthcare professionals in developing an empathetic approach to sharing information, and involving patients in shared decision making about their healthcare.

Cervical cancer is one of the top three cancers diagnosed in women globally. When women have access to a testing programme, abnormal cells can be detected to prevent the development of cancer. Research to date indicates that social and cultural barriers are the top two barriers in accessing cervical screening. In Ireland there may be a lack of trust in the National Cervical Screening programme due to previous mishandling of tests, and media coverage of the impacts of inaccurate screening results in Ireland. To understand impact of the health scandal on womens trust in cervical screening in Ireland, nine Irish women ages between 25-65 were interviewed. Data was thematically analysed using a feminist perspective to centre the womens voices in making sense of their appraisal and engagement with services. The data analysis resulted in four themes: Personal Reflections on Systemic Failure; Collective Concern and Blame; Decision Making Influencers and Rebuilding Knowledge and Trust. This analysis conveys distrust in the Irish Cervical Screening programme, feelings of anger, and a sense of neglect from the services. Irish women now place their trust in each other, the experience of their friends, families, their local GP. We discuss these finding to explore how Irish women have reinterpreted the narrative over the screening test in Ireland, and the potential to decrease concern around the topic by incorporating this experience into official narratives. This scandal heightened existing distrust and concern for the quality of womens screening services, and therefore has global relevance which can be applied to screening services more generally.

Remote consultations, including telephone, video, text or web-based consultations, are now common in sexual and reproductive health services (SRHS) in England and Wales, offering convenience and efficiency but raising concerns about safeguarding service users compared to in-person care. Ensuring protection and support for individuals remain central to SRHS. While guidance exists, evidence on how safeguarding is enacted remotely is limited. This study explores how safeguarding is managed in remote SRHS, examining associated challenges, benefits, and perceptions of acceptability. This qualitative study, part of the CONNECT study (NIHR153151), explored safeguarding in remote delivery of SRHS across three diverse case study areas in England and Wales. Semi-structured interviews were conducted with service users and providers (March 2024-January 2025). Data were thematically analysed using inductive and deductive approaches. Eighty-nine interviews were conducted with 54 service users/potential service users and 35 professional stakeholders across three study sites. Four key themes were identified: (1) challenges of delivering remote safeguarding in practice, (2) importance of a safe space for the patient, (3) one size approach does not fit all, and (4) strategies to support remote safeguarding. Participants described difficulties identifying risks without visual cues, variable comfort with disclosure, and privacy concerns. Providers used adaptive, collaborative approaches to build trust, ensure safety, and tailor safeguarding to individual circumstances. Both service users and providers recognised the effectiveness of remote safeguarding largely depended on clinician judgement, structured questioning, and sensitive communication. While remote consultations offered flexibility, remote safeguarding relied on service users having access to safe, private space. People with language barriers or those less able to create a safe space at home, such as those experiencing housing instability or coercive control may also have greater safeguarding needs. Ensuring access to in-person options, clear safeguarding protocols, and appropriate clinician training is essential to mitigate these challenges. Author summaryDuring the COVID-19 pandemic, sexual and reproductive health services used more remote appointments, such as phone, video, or online consultations. These appointments can make it easier for some people to get care. But there are concerns about whether staff can spot safeguarding issues, such as people who may be at risk of harm, without seeing them in person. In this study, we spoke with people who use sexual and reproductive health services, people who had never used these services before, and staff who work in these settings. People described challenges with remote appointments, including not being able to see body language, feeling unsure about talking about sensitive issues, and worries about privacy at home. Staff described changing how they worked by asking careful questions, building trust, and making safeguarding fit each persons situation. Both service users and staff felt that keeping people safe during remote appointments depends on clear communication and professional judgement. It is harder when people do not have a private space, face language difficulties, or live in unsafe housing or controlling relationships. Our findings show the importance of keeping in-person appointments available and making sure staff have the right training and guidance.

BackgroundRemote consultations (via telephone or video) were critical during COVID-19 restrictions for Sexual and Reproductive Health Services (SRHS) in England and Wales and continue to be implemented widely. However, there remains limited evidence on their impact on outcomes and health inequalities. This study, guided by the Framework for Digital Health Equity, explores the equity implications of remote sexual health consultations in England and Wales, examining their acceptability and appropriateness. MethodsWe conducted semi-structured interviews with 54 service users and potential service users and 35 professional stakeholders across three diverse case study areas. Participants were purposively sampled to ensure diversity in socio-demographic profile and service experience. All participants provided informed consent, and ethical approval for the study was granted by NHS Research Ethics Committee (REC: 23/NS/0128). Data were thematically analysed into narrative themes, with findings interpreted collaboratively with public and patient involvement groups. ResultsThe study found that remote consultations have reshaped care delivery, improving efficiency but also generating additional clinical workload and, for some clinicians, reduced job satisfaction. While generally acceptable, remote models were perceived to affect rapport, extend care pathways for some service users, and impact privacy and safeguarding. We found the benefits of remote consultation are unevenly distributed, with those experiencing digital exclusion, who lack access to suitable private spaces, or who experience language barriers, being less able to take advantage of their convenience. ConclusionsRemote consultations transform SRHS delivery, improving efficiency for some but introducing challenges by impacting interaction, equity, and confidentiality. Benefits and burdens are unevenly distributed, reflecting structural, social, and individual factors influencing access. SRHS must ensure equitable access to appropriate care for all populations when implementing remote consultations. The findings show that a one-size-fits-all approach is not appropriate, and that giving service users choice in how they consult, including in-person, is important.

ImportanceFrequent exposure to patient death may challenge oncologists well-being and compromise care quality. Despite these risks, evidence on how patient death affects oncologists across different healthcare settings remains limited. ObjectiveTo explore how patient death affects oncologists, focusing on personal and professional impact, coping strategies, and perceived support and educational needs. DesignQualitative study based on semi-structured telephone interviews conducted in 2024, analyzed using deductive-inductive content analysis. SettingInterviews with oncologists from various specialties, working in inpatient and outpatient adult cancer care settings across Germany. ParticipantsOncologists working within the German health care system with experience of at least one patient death were eligible to participate. Participants were recruited using purposive maximum-variation sampling. None withdrew after enrollment. The sample included a range of clinical roles and levels of experience. Intervention(s) or Exposure(s)Cross-sectional observational study without intervention. Main Outcome(s) and Measure(s)Participants descriptions of personal and professional effects of patient death, their coping strategies, and their reported support and educational needs. ResultsThe sample included 23 oncologists (13 male) from diverse oncological specialties. Participants reported a wide range of personal and professional responses to patient death, from no impact to significant distress, but also described experiences of personal and professional growth. Emotional responses included sadness and helplessness, but also feelings of relief and satisfaction. Lasting effects, including shifts in clinical approach and life perspective but also adverse outcomes such as difficulty separating work from private life were reported. Common coping strategies included peer support, clinical reflection, professional distancing, and both team-based and individual rituals. Barriers to coping included taboos around death, blame dynamics, time constraints and unclear access to institutional support. While many reported no current unmet needs, the findings nonetheless revealed gaps in medical education and a demand for low-threshold support formats. Conclusions and RelevancePatient death can have lasting personal and professional impact on oncologists. Interventions addressing educational gaps and providing low-threshold support may help strengthen oncologists well-being and sustain care quality. Trial RegistrationNot applicable (qualitative observational study). Key pointsO_ST_ABSQuestionC_ST_ABSHow do oncologists experience and cope with patient death, and what support needs do they perceive? FindingsIn this qualitative interview study, oncologists described a wide range of personal and professional effects of patient death. Coping strategies included informal peer support, clinical reflection, professional distancing, and both team-based and individual rituals. While many participants reported no unmet support needs, the findings nonetheless revealed gaps in medical education and a demand for low-threshold support formats. MeaningPatient death can have lasting personal and professional impacts on oncologists, underscoring the need for accessible and structured support.

BackgroundDelivering recommended intensity of neurorehabilitation remains a challenge, with telerehabilitation offering one solution. NeuroRehabilitation OnLine (NROL) is a multidisciplinary, group-based telerehabilitation model embedded within one region in England, showing promise and alignment with healthcare strategic priorities. The importance of scaling successful evidence-informed practices is recognised, however careful adaptation is required to ensure contextual fit and sustainability. This study describes the adaptation of NROL for implementation in a new context. MethodsThe four-step ADAPT guidance was applied with previously identified implementation strategies to guide the adaptation of NROL from Region 1 to Region 2. Adaptation activities were co-produced. Contextual factors were detailed using the Consolidated Framework for Implementation Research and Intervention Sustainability Assessment Tool. The adapted innovation was described using the TIDieR-Rehab checklist. ResultsNROL was successfully adapted for Region 2. Step 1 confirmed strategic fit but identified barriers including workforce, infrastructure and resource. Led by an adaptation team and supported by a learning collaborative, Step 2 responded to barriers, retaining core components while tailoring role configuration and materials. Step 3 demonstrated feasibility and acceptability through piloting and phased integration, and improved fit within service pathways. Step 4 focused on sustainment, supported by training, stakeholder engagement, and reporting. DiscussionThis study offers a transferable approach for scale-up, providing an example of context-sensitive adaptation to a new region, demonstrating how frameworks and co-production can support the adaptation of telerehabilitation models. This example has potential wider use for researchers and implementers tasked with delivering impact, though highlights the effort and resource needed. PLAIN LANGUAGE SUMMARYStroke and neurological rehabilitation services often struggle to provide enough therapy due to staffing and system challenges. Digital delivery of rehabilitation offers one solution. NeuroRehabilitation OnLine (NROL) is a programme that offers live, group therapy and peer-support remotely for people recovering neurological conditions. It has been delivered within one region of England, showing promise and alignment with healthcare priorities. The importance of spreading successful, evidenced practices is recognised, but requires careful consideration to ensure they fit well and can be continued in the new location. This study explains how NROL was adapted for use in a second region. The four-step process called the ADAPT guidance was used with previously identified practical strategies to guide changes to NROL for Region 2. Relevant staff from both regions worked together to ensure the programme met local needs. Evidenced tools were used to understand what made the new region different and to describe the adapted programme clearly. NROL was successfully adapted for Region 2. Step 1 confirmed NROL alignment with healthcare priorities but highlighted challenges including limited staffing and resource. Led by a small team, Step 2 responded to challenges. The core parts of NROL were kept the same, like live group therapy and technology support, but changes were made to the staffing structures and materials. Step 3 tested the changes with small pilot groups and used feedback to improve the programme before wider roll-out and refinement. Step 4 focused on maintaining and reporting the adapted programme. This work offers a transferable approach for spreading evidenced health innovations, providing an example of local needs driving relevant change, and demonstrating how tools and teamwork can support the adaptation process of digital health programmes. This example has potential wider use for researchers and clinical staff tasked with delivering change, though highlights the effort and resource needed.

The ideal interpregnancy interval (IPI) following a miscarriage is controversial as the World Health Organization (WHO) advise women to delay pregnancy for at least six months. Subsequent research has found that IPI less than six months is beneficial for both mother and baby. The impact of this guidance on the decision-making process for couples/women in this predicament is unknown. Views of women regarding the optimum IPI following miscarriage were investigated using a thematic framework applied to discussion threads from a popular online forum, Mumsnet (https://www.mumsnet.com). A systematic search of all online information was also undertaken to identify all relevant patient information regarding conceiving another pregnancy after a miscarriage. The findings from the search were tabulated and analysed in relation to the themes identified from the discussion threads on Mumsnet. Ninety-four discussion threads were included. Women saw no reason to wait if they felt ready. Women posted about their frustrations at the multiple sources of conflicting advice they received, at the lack of professional sympathy and felt that being told to wait before trying to conceive after a miscarriage was outdated advice. However, these findings were not corroborated by the patient information currently available online. All web-based patient information gave consistent advice - to wait for at least one normal period before trying to conceive again after a miscarriage and to try for another pregnancy when they felt physically mentally and emotionally ready. None advised waiting for six months. This study highlights that sometimes despite contradictory clinical advice, women are keen to make their own decisions regarding reproductive choice. These decisions are often empowered by peer support and advice which women trust over inconsistent information received from healthcare professionals. In this case, health information appears to have been updated in response to womens choice rather than the other way around. Research highlightsO_LIA knowledge gap exists in relation to the views of women regarding the ideal interpregnancy interval following miscarriage. C_LIO_LIThis study provides insights into the views and beliefs of women regarding the IPI following miscarriage C_LIO_LIThe dominant themes emerging from the study were: there is an array of conflicting advice being provided; there is no requirement to wait following a miscarriage; and the right time is when a couple feels physically, mentally and emotionally ready to try for another pregnancy. C_LIO_LICurrent web-based information for patients does not endorse the WHOs guidance of waiting for at least six months before trying to conceive again after a miscarriage. C_LI

Backgroundof the 300,000 Jews living in the UK today, 19% identify as Orthodox. High fertility rates within some of the community sub-groups make interactions with NHS maternity services frequent. The unique lifestyle and religious customs of community members have the potential to make these interactions complex and confusing for both NHS staff and community members. Aimsto identify relevant studies and map the literature concerning the interaction of Orthodox Jewish couples with maternity services and identify gaps in the literature. Methoda scoping review, undertaken in line with the methodological framework of Arksey and OMalley, following PRISMA and JBI guidelines. We searched CINAHL, SocINDEX, Medline, ProQuest, Web of Science and grey literature. Resultsof the twelve included studies, ten were qualitative and two were quantitative. The geographical locations included Israel and North America, with no studies conducted in the UK. Half of the studies were carried out over 10 years ago. Using Thomas and Hardens thematic synthesis, five analytical themes were identified: 1. Between the Divine and the Earthly: Negotiating Faith and Modern Medicine. 2. Holding Space or Holding Back: The Role of the Husband and the Community. 3. Born to Become a Mother, through Joy and Hardship. 4. Praying Quietly: Coping Mechanisms. 5. Keeping it Kosher: Religious and Maternity Care. Conclusionthe maternity experiences of Orthodox Jewish couples reflect unique needs shaped by a complex interplay of faith and risk-based medicine. The centrality of the community serves as a double-edged sword, offering vital support while also imposing restrictions and norms. There is an urgent need for high-quality research in the UK into the needs and experiences of Orthodox Jewish couples to inform NHS policies.

BackgroundWomen with limited or no English proficiency experience persistent barriers to accessing maternity care in the UK, contributing to well-documented inequalities in maternal and perinatal outcomes. NHS parent education classes are predominantly delivered in English, and provision of multilingual classes within individual maternity units is often limited and duplicative. Evidence to inform collaborative, cross-trust service models remains scarce. ObjectiveTo assess womens access to, preferences for, and perceived relevance of NHS parent education classes, with particular focus on willingness to travel across London to attend classes delivered in a preferred language, in order to inform equitable and efficient service design. MethodsA cross-sectional, multilingual survey was conducted as a quality improvement initiative across multiple London maternity networks. The survey was translated into 18 languages and captured sociodemographic characteristics, access to parent education, preferences for delivery format, timing, location, and language, and perceived relevance of content. Quantitative data were analysed descriptively and thematically. ResultsA total of 97 women participated in the survey (n=97), the majority of whom reported speaking at least one non-English language at home (79.4%, n=77). Regarding mode of delivery, 51.6% of women preferred in-person parent education classes (n=50), 15.5% preferred online delivery (n=15), and 32.9% reported no preference (n=32). Most participants reported access to a suitable device and reliable internet (85.6%, n=83) and confidence using online platforms (77.3%, n=75). In relation to timing and format, weekends were the most commonly preferred time for classes (40.2%, n=39), followed by weekdays during school hours (35.1%, n=34) and weekday evenings (24.7%, n=24). Nearly half of women preferred delivery across two 2-hour sessions (48.5%, n=47), while 30.9% reported no preference regarding session length or number (n=30); fewer preferred two 3-hour sessions (11.3%, n=11) or a single 4-hour session (8.3%, n=8). Regarding willingness to travel, 67.0% of participants reported they would attend parent education classes delivered outside their booking maternity unit (n=65). Overall, 68.0% were willing to travel up to 45 minutes for in-person classes (n=66), while 29.9% preferred not to travel (n=29). With respect to language of delivery, 40.2% of women preferred classes delivered in their native language (n=39), and a further 40.2% reported English with an interpreter as acceptable (n=39); fewer were comfortable relying on a partner or friend to translate (19.6%, n=19). Most participants perceived that delivery by a native-speaking health professional would improve trust and learning (75.3%, n=73), and an equal proportion expressed a preference for a female interpreter (75.3%, n=73). ConclusionsWomen with limited English proficiency demonstrate clear willingness to travel across maternity networks to access antenatal education in their preferred language. These findings support the development of collaborative, cross-trust models that standardise core antenatal content while centralising multilingual provision, reducing duplication and improving equity of access across London maternity services.

BackgroundPrimary care is well placed to provide preconception care. To support primary care professionals in meeting the preconception care needs of prospective parents, an understanding of their perspectives and experiences of providing preconception care is needed. As women consult with a range of primary care health professionals for preconception care, including general practitioners (GPs), midwives, and naturopaths, this study aimed to explore these health professions beliefs and attitudes towards preconception care and describe their preconception care practice behaviours in Australia. MethodsQualitative methods were employed. Focus groups and interviews with health professionals (n=18) in clinical practice (more than 5 years) within Australia were conducted between May and August 2021. Health professionals comprised GPs (n=6), midwives (n=5), and naturopaths (n=7) and were recruited through professional organisations. Fieldwork explored the practice services provided, beliefs and attitudes towards preconception care, and preconception care practice behaviours. Data analysis used a framework thematic analysis approach. ResultsThree major themes were identified: Defining preconception health and care (subthemes: defining preconception health and defining preconception care), Understanding primary practitioners role in preconception care (subthemes: the GPs role as central to preconception care, role is holistic, educational, and empowering and role of personal experience and gender in being a preconception care provider), and Situating preconception care in primary care practice (subthemes: preconception care patient populations, preconception care within broader health services and preconception health information sources are varied). ConclusionsWhile health professionals shared similar views on the factors that comprise preconception health, some components of preconception health differed among the health professional groups. Although it is universally agreed that GPs are key providers of preconception care, they are not the only health professionals with a role. A wider range of health professionals could aid in meeting the preconception care needs of people of reproductive age with greater coordination among them. To improve the provision of multi-disciplinary preconception care further insights into shared and complementary responsibilities among health professionals in primary care settings are needed.

Pregnancy requires appropriate guidance and support from healthcare professionals. Understanding womens experiences of effective patient-provider communication through antenatal care is critical, as evidence suggests, inadequate communication could pose various risks to maternal and neonatal well-being. Despite efforts to modernise maternity services, recent assessments reveal persistent challenges, with nearly half of maternity services inspections categorised as inadequate or requires improvement. This qualitative systematic review investigated effective patient-provider communication in antenatal care settings across England, contributing essential insights into womens experiences and feelings from various backgrounds. MethodsThis study utilised the PICo framework to formulate the research question, focusing on effective patient-provider communication in antenatal care settings across England. A comprehensive search involving various study types was conducted across electronic databases from 2010 onwards. Inclusion and exclusion criteria were predefined, and relevant studies underwent thorough screening. Data synthesis involved a qualitative descriptive approach, employing thematic analysis to capture diverse experiences. Findings were summarised through coded extracts, supporting quotes, and a narrative addressing womens experiences. ResultsThe search identified 46 records, with six studies meeting the inclusion criteria. Results were synthesised utilising thematic analysis approach. Subsequently, five themes were distinguished: Responsive and engaging communication; Individualised treatment; Clear presentation of service information and informed choice; Continuity of care; and Additional ways of communication. The study identified key suggestions to improve patient-provider communication in antenatal care, including tailored training programmes aimed at HCPs focusing on empathy, active listening, building emotional connections, establishing trust, and providing continuity of care. Recommendations also emphasise transparent information and empowering women through communication. Likewise, suggestions extend to the incorporation of cultural safety training initiatives and addressing structural issues within the system. The study, however featured experiences of minority ethnic women, which may potentially impact results, limiting the findings generalisability. In addition, measuring womens views amid the emotional intensity associated with pregnancy presents inherent challenges, hypothetically affecting the depth of understanding of the experiences. ConclusionFew key conclusions derived from women experiences highlight the need to re-address barriers to communication. Proposed strategies offer practical steps, but further research is urged to address emerging challenges by advocating for improved communication strategies in order to enhance prenatal care nationally.

BackgroundMultiple barriers limit access to traditional in-person clinician sampling for cervical cancer. The STAMP (Screening with Tampons: Evaluating Diagnostic Accuracy for HPV and Assessing Participant Views) study evaluated the diagnostic accuracy and acceptability of tampon-based self-sampling for HPV amongst people assigned female at birth. Encouraging technical performance of the tampon as a sample for microbial detection was observed relative to clinician-taken samples. Pre and post trial questionnaires and a nested qualitative study explored acceptability. MethodsAll participants (n=263) completed questionnaires before and after sampling using three methods: tampon-based self-sampling, swab-based self-sampling, and clinician-collected samples. Questions included comfort, trust and ease of use of tampon-sampling. Four focus groups (n=24) were conducted online, and analysed using reflexive thematic analysis. ResultsQuestionnaire responses suggested tampon-based self-sampling was highly acceptable. Qualitative analysis identified four key themes: advantages of self-sampling over clinician-sampling; unique benefits of tampon-based self-sampling; concerns about accuracy and trust; and confidence in correct use. Participants valued the physical comfort, psychological ease, and practical convenience of self-sampling compared to clinician-sampling. The familiarity of tampons as an everyday product was central to acceptability, normalising screening. While some initially questioned accuracy, most were reassured by evidence of performance. Clear instructions and understanding the evidence base boosted confidence. ConclusionFindings suggest that tampon-based self-sampling is a highly acceptable alternative sampling approach for cervical screening that may increase screening participation by addressing multiple barriers. Implementation strategies should emphasise the methods everyday nature, while providing accessible guidance to support correct usage. What is already known on this topicO_LISelf-sampling for Human Papillomavirus (HPV) has been recommended by the World Health Organisation as an additional approach to expand cervical cancer screening services, complementing conventional clinician-taken sampling to broaden access and address barriers associated with in-person care. C_LI What this study addsO_LIFindings from this study suggest that self-sampling has the potential to support screening for cervical cancer as an acceptable, at-home approach addressing physical, psychological and practical barriers associated with traditional clinician collected sampling. C_LIO_LIParticipants reported that the familiarity of using a tampon for self-sampling creates a unique advantage over other self-sampling methods through demedicalising and normalising screening, therefore potentially increasing accessibility and participation among underscreened populations who experience most barriers. C_LI How this study might affect research, practice or policyO_LISelf-sampling including tampon-based self sampling offers a promising, acceptable approach to achieving cancer elimination goals. C_LIO_LIImplementation of tampon-based self-sampling for HPV should be clear, comprehensive and accessible, incorporating visual aids and simple language while emphasising the rationale and scientific evidence behind the collection method C_LI

ObjectivesTrans and/or gender diverse (T/GD) people in the UK are less likely to access sexual health services (SHS) than cisgender people but are more likely to report negative experiences. The British Association for Sexual Health and HIV (BASHH) developed expert recommendations for T/GD-inclusive SHS, but these lack service user perspectives. This study addressed this gap by asking T/GD people how SHS could be T/GD-inclusive. MethodsSemi-structured interviews (n=31) and focus groups (n=21) were conducted with T/GD people aged 17-71 years old recruited through community organisations and social media, exploring experiences of SHS and inclusivity. Study design, materials, and analysis were informed by T/GD people and an advisory committee of charities and sexual health clinicians. Data were analysed using thematic analysis, managed using NVivo. ResultsParticipants often expected that SHS were not set up for T/GD people. This was reinforced by poor experiences in other healthcare settings and the lack of information on NHS websites. Some participants had been denied care because they were too complex. Participants wanted to know that SHS had engaged with the needs of T/GD people and looked for hallmarks of inclusivity, such as Trans Pride flags in reception areas. Some participants wanted specialist T/GD services, but others preferred to access general SHS. Staff attitudes were a key factor underpinning inclusivity. Anticipating having their identity questioned or needs dismissed, participants sought kindness and openness. Although the needs of T/GD people are diverse and different from cisgender service users, participants stressed that SHS staff already had the skills to deliver sensitive person-centred care and emphasised the value of inclusive SHS. ConclusionThese findings provide insight into what a sample of T/GD people in the UK consider important for T/GD-inclusive SHS. Participants suggestions aligned with and reinforce BASHH expert recommendations. Importantly, they highlight the need for ongoing engagement to deliver T/GD-inclusive SHS. Key messagesO_ST_ABSWhat is already known on this topicC_ST_ABSO_LITrans and/or gender diverse people are less likely to engage with sexual health services than cis-gender people C_LIO_LIThe British Association for Sexual Health and HIV (BASHH) Gender and Sexual Minority Special Interest Group (GSM SIG) has developed expert recommendations for trans-inclusive sexual health services, but user perspectives are missing C_LI What this study addsO_LIParticipant suggestions and preferences for inclusive services support BASHH GSM recommendations C_LIO_LIParticipants looked for inclusive SHS that recognise, understand and affirm their needs C_LI How this study might affect research, practice or policyO_LIEnhancing T/GD inclusivity involves active engagement with clinical spaces, processes and delivery C_LI

Background and AimsDespite advances in cervical cancer prevention through HPV vaccination and self-collection screening options, participation remains disproportionately low among culturally and linguistically diverse (CALD) women in Australia. Despite national policy efforts, uptake remains low. This study aims to bridge the gap between policy and lived experience by synthesising evidence and capturing perspectives to understand why screening remains inaccessible - and how it can be transformed. MethodsA narrative review of peer-reviewed and grey literature (2015-2024) was conducted to identify structural and cultural barriers affecting cervical screening participation in CALD populations. Key themes were mapped against the socio-ecological model. In parallel, semi-structured interviews were conducted with eight multicultural health workers and cultural advisors across South Australia. Thematic analysis was used to identify recurring patterns, community insights, and practice-level solutions. Ethics approval was granted by the University of South Australia Human Research Ethics Committee. ResultsLiterature consistently reported language barriers, lack of culturally safe information, and limited awareness of self-collection options. Interviewees deepened this with lived insight, describing mistrust, stigma, and fear, especially among women from refugee and faith-based communities. They proposed actionable strategies: co-designed messaging, partnerships with cultural leaders, and embedding screening education into womens community spaces. Importantly, the disconnect between national messaging and local realities was seen as a critical barrier to meaningful engagement. Conclusions and Significance/ImpactThis study reveals that closing the cervical screening gap for CALD women requires more than information -- it demands cultural trust, community leadership, and policy grounded in real-world experience. By combining evidence with voice, it offers a roadmap for developing inclusive, community-led screening programs. The findings advance translational public health by demonstrating how innovation begins with listening -- and leads to systems that truly work for all.

BackgroundMost surveys examining health professionals knowledge, attitudes and practices around abortion have used convenience samples and have targeted doctors. Our goal in the SACHA Study, drawing on evidence-based strategies to maximise response rates, was to achieve a representative sample of a wider range of health professionals, working in general practice, maternity services, pharmacies, sexual and reproductive health (SRH) clinics and specialist abortion services in Britain, to explore the knowledge, attitudes and experience of abortion care and views on future models of delivery. MethodsA cross-sectional questionnaire-based survey of midwives, doctors, nurses and pharmacists in England, Scotland and Wales was undertaken between November, 2021 and July, 2022. We used a stratified cluster sampling approach to select a random sample of sites and all eligible staff within those services were asked to respond to the survey. Evidence-based strategies to maximise completion rates were adopted, including postal delivery of the one-page questionnaire with personal letter of invitation and a stamped address envelope for return, inclusion of an unconditional voucher and follow-up. ResultsOverall, 147 of the 314 (46.8%) health service sites randomly selected took part in the survey. Reasons for non-participation included local Research and Development (R&D) Department non-response, lack of resources or insufficient time to support or approve the study, lack of interest in or perceived relevance of the topic and insufficient capacity to take part, exacerbated by work demands during the COVID epidemic. Of the 1370 questionnaires sent to eligible identified participants within these services, 771 were completed and returned (56.3%). At the service level the highest proportion of returns was from SRH clinics (81.0%) and the lowest from general practice (32.4%). In relation to profession, returns were highest amongst midwives (69.6%) and lowest amongst pharmacists (36.5%). ConclusionsObtaining information about health professional knowledge, attitudes and practices is key to guide service development and policy and to identify gaps in training and service provision in abortion. Despite our attempts to gain a representative sample of health professionals, the challenges we experienced limited the representativeness of the sample, despite the use of an evidence-based strategy.

Over 300,000 children were born in the United Kingdom (UK) through assisted reproductive technology (ART). ART is associated with prematurity and congenital anomalies, while long-term health risks are currently considered low. Large-scale qualitative research exploring womens perspectives on these issues remains limited. Therefore, this study investigates womens concerns about health and educational outcomes following ART, and their views on information provision and national database studies. Women who underwent ART, were considering ART or conceived naturally were invited to participate voluntarily. An anonymous online survey was distributed via social media channels of a UK-based fertility charity and accepted responses for 8 months. Free-text responses underwent thematic analysis, and descriptive statistics were produced for categorical responses. Of the 562 participants, most were aged 25-40 (74.5%), White (93.2%) and held a degree or higher qualification (87.9%). The majority underwent ART through the private sector (42.3%) in the 2020s (69.1%) and had successful childbirth (52.4%). While up to 82.5% of respondents reported no health and educational concerns, others were concerned about reproductive, endocrine and hormone treatment-related cancer risks in themselves, in addition to potential reproductive, neurological and developmental issues in their offspring. Most participants (up to 91.9%) stated they received no information about ART-related health and educational outcomes in themselves and their child; those who did cited healthcare professionals or videos as sources. More than half (68.3%) supported using national databases to study childrens outcomes, and they expressed that such findings should be disseminated sensitively through healthcare professionals before treatment. Although most women reported no concerns or information about long-term health and educational outcomes for themselves or their children, many expressed concerns. The lack of information and support for database studies can inform patient-centred communication that addresses womens concerns. Future ART studies may consider incorporating patient and public involvement surveys to shape research priorities.

ObjectivesTo identify and map prehabilitation services for patients preparing for cancer surgery in the UK National Health Service (NHS) and understand how issues of accessibility and inequality are being addressed. DesignA survey based on the Template for Intervention Description and Replication and criteria for high-quality, equitable prehabilitation developed as part of our broader study. SettingNational Health Service organisations in the UK ParticipantsRepresentatives of prehabilitation services, who were mainly healthcare professionals. To be eligible for inclusion, services had to be part of the funded usual care pathway for patients in the NHS Trust or Health Board and offered, referred to, or signposted by the NHS cancer care team OutcomesThe primary outcome was the availability of a prehabilitation service to patients who were preparing for cancer surgery at a given NHS organisation. Where services existed, we collected data on service characteristics, the size and workload of the service, screening and individualised assessment for prehabilitation, interventions, addressing inequalities, and evaluation of the service. ResultsOf 130 NHS organisations which provided cancer surgery services, we received a response from 112 (86%). Of these, 73 (65%) stated that they had an eligible prehabilitation service, and 39 (35%) stated that they did not. We received detailed survey responses from 51/73 services (70%). These demonstrated variability across all survey domains. Most services involved physiotherapists (43; 84%) and dietitians (37; 73%), with a variety of other professions represented. Twenty-four services (47%) reported that they tailor initial assessments to account for patient characteristics, and most services reported that they take steps to address inequities of access, the most common being support for people who have barriers to accessing the internet (46; 90%). Only 19 services (37%) were in receipt of permanent funding. ConclusionsPrehabilitation provision for people preparing for cancer surgery varies widely across the UK, and this creates inequities in services. Nevertheless, prehabilitation services appear to be aware of the risk of unequal access, and are taking steps to address this. There is an opportunity to address inequalities as services are commissioned, developed and implemented. Strengths and Limitations of this StudyO_LIThis is the most comprehensive survey to date of prehabilitation services available to patients preparing for cancer surgery in the UK. C_LIO_LILocal collaborators helped us to identify services (or gaps in services) in 112 of 130 eligible organisations. C_LIO_LINevertheless, the localised and small-scale nature of prehabilitation services and inconsistent service naming conventions means we are likely to have missed some services. C_LIO_LIWe identified important variability in service design, funding, and how services address health inequalities. C_LIO_LIWhile variations are identified, the methodology of survey-based research means that explanations for this variation remain speculative. C_LI

IntroductionA Reproductive Life Plan (RLP) is a set of questions that encourage patients to reflect on their reproductive goals and the actions needed to achieve them. This scoping review of the published and grey literature aims to map the evidence on currently available RLPs. MethodsWe searched four databases (Medline, Embase, PsycINFO and Scopus) and used Google to search the grey literature, the search terms were; "reproductive life plan$" OR "reproductive plans$" OR "pregnancy intention screening". Data were extracted on target audience, format, content, behaviour change theory, features, effectiveness and acceptability. Results44 published papers and 18 grey literature sources were included. 21 RLPs were discussed in the published papers and 17 in the grey literature. Most RLPs came from the USA. Most RLPs in published papers were asked verbally, while all RLPs in the grey literature were self-completed; there were six digital RLPs. Most ask whether an individual wants children, some then ask about number and timing of children, and contraception. Grey literature RLPs also asked about lifestyle and health. DiscussionThe concept of developing an RLP is acceptable to people of reproductive age and healthcare professionals. There was a lot of consistency in the questions asked, however, there is limited data on effectiveness and only three tools, all digital, incorporated behaviour change theory. ConclusionA digital RLP that builds on the evidence for existing tools and integrates appropriate theory could result in the realisation of the potential that RLPs are theorised to deliver.

BackgroundGeneral Practitioners (GPs) play an important role in healthcare delivery for people living with a rare disease and their families. Managing long-term multisystem diseases that often have no cure and sub-optimal treatment options can be extremely challenging. AimTo gain an understanding of GPs perception and experience of rare diseases. Design and SettingThis is an exploratory study with GPs from Northern Ireland. MethodAn online survey was hosted within SmartSurvey, available for 6 weeks in early 2019, which queried: GPs career to date, interactions with rare disease patients, challenges faced, the exchange of information with patients, priorities for the future, support for such patients and finally training. ResultsSixty-six GPs engaged with the survey with 15 completing the survey. Many frustrations were mentioned by GPs when caring for such patients including finding a diagnosis, lack of specialist services and lack of awareness. Seventy-nine percent of GPs responding did not feel adequately trained to care for patients with a rare disease, while 93% were interested in undertaking training to enable them to improve their care for rare disease patients. ConclusionMore effective and convenient rare disease focused training programs would help GPs manage patients with rare diseases. Enabling efficient, effective communication between GPs and individual medical specialists is of paramount importance to give GPs access to information on how to effectively manage patients living with a rare disease. Awareness should be raised for effective support mechanisms such as charities and support groups for rare disease patients. How this fits inMany GPs have reported feeling overwhelmed when caring for rare disease patients. Their lack of knowledge forces them to turn to the internet but finding reliable information is often difficult. This study acknowledges the difficult task GPs face when caring for this population and highlights the need for training development, improved communication, and better awareness.

INTRODUCTIONPregnancy is a crucial period which ultimately directly impacts two individuals health and wellbeing. Within the UK, a standardised pattern of care is established with collaborations across disciplines to the benefit of women and babies. During the COVID19 pandemic, this pattern of care was disrupted to align with protective protocols which until now, has not been formally reported. METHODSA retrospective, mixed methods study of UK based women pregnant between the years 2012 and 2022 inclusive with no known complications was conducted to collate opinions and experiences of pregnancy with and without the impact of COVID19 restrictions. Quantitative results were analysed using the statistical package GraphPad Prism 9.2.0 and presented as mean values +/- standard deviation were appropriate. In addition, we used a phased approach to open ended questions. RESULTSOur results showed no significant difference in either the number of appointments or the time of first appointment however an increased percentage of women reported the use of private services during the COVID pandemic. There was no change in the number of midwife appointments during the postnatal period during COVID but there was a significant reduction in the number of health visitor appointments. Overall, the COVID pandemic led to women feeling less satisfied with their care both during their pregnancy and postnatally, but they reported that they continued to be listened to and remained feeling in control of their pregnancy. DISCUSSIONGenerally, the changes implemented during the COVID pandemic did not impact womens pregnancy journey substantially although we have no evidence of the long-term impact on child health and development. Clear themes have been established which can be used to further improve services in maternity and there are key elements to focus on for the future of UK maternity services.